Monday, December 15, 2014

A wonderful part about being a midwife is creating long-term relationships with people. Maybe not the kind of relationship in which I see past patients often or even keep in touch on a daily or weekly or monthly basis, but the kind of relationship that perseveres through time, with meaning that does not diminish as years go by or as people move away. I speak of a relationship that very often consists of keeping in touch to hear about birthdays and milestones, and mostly, simply remembering. Most anyone who has had a midwife that they loved during their pregnancy and birth will never forget that midwife. Most midwives who have had a patient who they have connected with, gotten to know well, or served in a particularly meaningful way will never forget that patient...or that birth.

Today I received this message from a past patient who has since moved away:

"Hey Tara! Our sweet Asher turned one today and we are reminded of your (and Dr. Elrods )help and support during this special day. We made a mad dash and nearly had him in our car, but you were my voice of reason and strength on the phone. I can not even express to you the comfort you brought me and that I much needed on that drive over. You guys make a great team! Thank you for being a part of our special day!"

I read this short message and it brought a smile to my face. I won't ever forget Ginni's labor. It was fast and furious! She had called me in labor, letting me know that she was contracting every 2 minutes. I told her to head to the birth center. I won't ever forget literally running out the front door of my house- which I do often, but not quite like this- yelling behind at Glen to come with me and HURRY UP!

Minutes later Ginni called to let me know that her water had just broke on her way out the door in heading to the birth center. I asked her the usual questions, assessing that everything was 'normal' and well. I told her not to panic but to simply get in the car and get to the birth center. I hung up the phone and as I was driving said to Glen, "She is going to call back in a couple minutes and tell me that she's pushing." Two minutes later my phone rings and it's Ginni- in control but scared- telling me that she was pushing. I'm on the phone, holding it with one hand and conservatively navigating the precarious roads with my left hand on the steering wheel. Ginni is crying. The roads are crisp white, blanketed in freshly fallen snow. There is no such thing as driving fast and rushing in the Alaskan winter of gentle snowfall. Ginni is trying not to push and doesn't know what to do. I tell her that it's ok. If she has to push, then don't panic...just relax and let your body push if you need to. I tell her to have her husband turn the heat on to get the car warm and to get something ready to wrap the baby in. I tell her, calmly but yet firmly to tell her husband to NOT STOP. "Tell him that if you are pushing or if the baby starts to come, do not stop driving. Do not pull over. Keep driving to the birth center, no matter what." A baby born inside a car certainly wasn't ideal for anyone, but a baby born in a stationary car on the side of the road was even worse.

We stayed on the phone together- her driving one direction and me driving another, both toward the birth center from equal distances. As she was pushing something dawned on me..."Ginni, do you have your pants on?" I envisioned a baby crowning into pants. Yes, she said. "If you are going to push then you have to pull your pants down. The baby can't be born in your pants." In such a situation, this is not at the forefront of anyone's mind.

We were just a couple minutes from the birth center. "Oh heck," I thought, "But what if the baby isn't born yet when we arrive to the birth center? Then she will have to get into the birth center with no pants on." It's amazing how even when things are happening relatively furiously and your brain is firing a million times at once, one is still capable of having long, detailed thought processes. I wasn't sure which was worse, the baby being born in her pants, or having to get her from the van to the birth center with no pants on.

We pulled up to the birth center at the same time. As we were pulling in, Glen took off his seat belt, in preparation of jumping out to help. He flew out one way and I the other- him to assist Ginni's husband in helping her and I to unlock the birth center door. We got into the birth center, pulled down the bed coverings, and 2 minutes after arrival, a beautiful, healthy baby boy was born.

To this day, Ginni holds the record for shortest time from arrival to birth. I won't ever forget the birth of Asher, nor will I forget how strong Ginni was while being within the eye of the storm!Happy Birth Day to the both of you, Ginni and Asher.

Wednesday, November 19, 2014

My day began shortly after 6:00am. A call from a patient in labor. The answering service patched her through and the voice on the end is a long, steady moan, which trails along for a full minute. I look at the clock to register what time it is: 6:05, my phone says. "Let's meet at the birth center at 7:00. That will allow me time to get there before you and set up," I tell her. We hang up and I call Mary and Shelby, our two apprentices. They will be on their way.

I get up and as I'm getting dressed, Glen gets Callen changed, dressed, and ready to go along with me. Baby Callen and I head to the birth center.

As I pull up I see the laboring mom standing outside. I told her 7:00 and yet she's there early. She's standing outside at the birth center entrance, laboring in the crisp Alaska cold. Thankfully it's a mild morning at 40 degrees.

I jump out of the car, apologize that she beat me there (hey, I did say 7!), grab Callen in the carseat and run to the door to let us in. I punch in the code. The door doesn't unlock. I punch it in again. It doesn't unlock. I enter the code yet again, this time slow and methodical. No luck. I try a few more times for good measure and to make sure I'm not losing my mind. Nope.

I run to the car and put Callen back in. 40 degrees may be mild but it is cold for a baby. I run to the front of the building- mom laboring, leaning against her car- and enter the code on the front door. It doesn't unlock. I try again. Still, it doesn't unlock. I call Glen as I run back around to the birth center door, I'm sure waking him from a dead sleep. "Where the hell is Mary?! I can't get in! Why isn't the door working?! Can you call Vivint right now?!" I don't even give the poor man a second to answer any of it and I'm pretty sure I hang up on him. I go back to the side door to try again. I'm contemplating in my mind which stone I'm going to pick up and whether it will be best to break the glass on the door or the window.

I enter the code again, making sure- again- that I'm getting it right. It should be unlocking the damn door and it's not. The definition of insanity crosses me mind. "I'm doing the same thing over and over again, expecting a different result." I enter it again, one final try before I shatter some glass and crawl through a window. And it works. We're in.

Thankfully the rest of the birth is unlike our entrance and goes smoothly- a first time mom has a beautiful, calm, unmedicated birth, and meets her baby girl.

The relationships I form with my clients vary widely in their degree, depth, and meaning. Most clients I bond with, but some more than others- with a handful developing into relationships I know I will have and treasure for years to come. Birth unfolds a new level of understanding that wasn't present prior. It's one thing to see and know a woman during pregnancy, spending 30 minutes, sometimes an hour, with her. It's another to be with her during birth.

I looked at this mom today and had such a better, deeper understanding of her and for her.

You get to know someone on a different level when you see them outside of their normal comfort zone- whether it be within the parameters of pain, anxiety, excitement, or anticipation that you witness.

During the postpartum course, I figure I can wear Callen. Shantel and I attempt to configure Callen in a side-carry using the Ergo, since I can't find my ring sling. I say configure because that's what it felt like...along with some guestimation. I walk into the birth room looking ridiculous and Shelby takes one look at me and we bust up laughing. Mary looks at me and informs me that I should probably refrain from posting my picture on the Babywearers Page because I'm in the midst of a baby wearing fail. Shelby takes Callen and wears him while I do vitals.

The new mom and her family oooh and ahhh over Callen. Mom is amazed that her baby will likely be about Callen's size in a mere 7 weeks. Oh, the time flies with these sweet babes.

The feeling in the room is happy...happy and proud.

I'm proud of this mom- not just for accomplishing Birth, but for being such a beautiful, positive person even with some not-ideal circumstances. I'm proud to now know her that much deeper and I'm proud to be her midwife.

Sunday, October 19, 2014

Birth for me is very vulnerable...though, vulnerable not in the sense of being broken down and susceptible, exposed and weak (because in labor and birth I know and feel I am anything but these things). Birth for me is feeling vulnerable to the world...vulnerable in cognizance and coherence of how fragile life is, how powerful yet also how delicate the body is, and, perhaps the most physically, emotionally, and mentally possessive- the awareness of how very little control we truly have.

I knew going into this birth that my support people mattered very much to me. I knew I likely wouldn't need much from them, only their presence and perhaps reassuring words, but that these two things mattered greatly to me. We planned to have our midwife, Peggy, our doula, Mary (who is also our student midwife that works alongside us), and my cousin, Melissa, as support.

Melissa flew in from California and planned to stay two weeks. When she arrived I was 39+2 weeks. Having had Aubrey at 38 weeks, Ethan at 39, and Adria at 40+4, the running joke was that I would likely continue this trend and go slightly longer with this pregnancy. Of course, labor and birth are unpredictable, so we surely didn't know for certain. Just over 39 weeks seemed like a safe time for her to arrive- unlikely that I would deliver before then, and unlikely that two weeks later- at 41+2 weeks- I would still be pregnant.

No surprise to any though, my due date came and went...and the days ticked by, with Melissa and Glen getting more anxious. I felt so good and so not as if my body were ready (literally no signs of anything), I began wondering if my dates were correct. Ha! Perhaps a bit of "nearing-41-week-denial!"

On the Sunday before 41 weeks (40+6) we awoke to a beautiful day. The air was cool with just a slight Autumn crisp to it, the sky was a perfect blue and sparred of the presence of even the slightest speckle of cloud. This beautiful day could not go unused- and so we set off for a day trip to Talkeetna.

We ate at the local brewery, perused the small, eclectic gift shops, and made our way to the river bank, where Denali was clearly exposed, in all her glory. There remained not a cloud in the sky, and both Glen and I repeatedly marveled and remarked at how we had never before seen Denali so clear and unobscured. Even with our repetitious awe, I am not quite sure Melissa understood what a rare presence we had. The world around us was glorious.

As the next day I would officially be 41 weeks, on the way home from Talkeetna we stopped at the office and did an NST and an AFI. All was well. With Melissa set to leave on Wednesday, both her and Glen were getting anxious. But, it was what it was- I felt great, and baby was active and still doing well.

The next day, we met with our midwife, Peggy, for a prenatal appointment. I am not one for vaginal exams (and am quite a baby when it comes to them, apparently), but I felt it wouldn't be unreasonable to have Peggy check me, and if possible, "strip my membranes" to see if it would help to get things going. She checked me at the end of our appointment and I was 3cm, 50% effaced, and -2 station. She was able to strip my membranes and then left, knowing that she might be hearing from me later that night. Or...it could do nothing.

The kids went to bed, and then Melissa went to bed...both not without being adamant that I was to wake them up should anything start happening.

10:30pm and my contractions were regular but not very close together. As I would advise any of my own patients to do- I ignored them as best as I could and didn't time them. If I had to guess, I would say they were about 10 minutes apart. Glen and I laid there for nearly 2 hours- just together in the quiet, dark room, side-lying together with him holding me from behind. I remember whispering to him how much I liked laboring with him, quietly, just the two of us. No fuss, no noise, just us.

A little after midnight, I needed a change of position. The contractions still were spaced out but when they were happening, they were much stronger. I got in the shower for a bit. Not long after that, at about 12:30am, I told Glen that though it might be on the early side, he should text Mary (our doula) and tell her to head over. She too had been adamant about me not waiting until the last minute to call her (for fear that she would miss the birth), and so I was taking this into consideration. It dawned on me that we hadn't even mentioned to Peggy that I was in labor. I all of a sudden had my midwife hat on, thinking of how much I would not like it if a patient of mine was in communication with her birth team but not keeping me in the loop as well. I verbalized this to Glen and told him he should text Peggy and tell her that maybe she should head over too. I then changed my mind and said nevermind- I didn't want her to come over and just be sitting at the house for hours. "Maybe you should check me first." He had already sent her a text by this point but went ahead and checked me. I was 5cm, 90% effaced, and 0 station. "It's too early to have her come. Tell her nevermind, we'll call her when I'm closer." He went to tell her nevermind but she was already on her way. "Ok," I said, "Then she can just get comfortable on the couch and get some sleep until I'm further along." I was so worried about her being here for hours and hours unnecessarily. I felt bad thinking that she would be at our house for hours in the middle of the night.

Mary arrived, Peggy arrived, and we let Melissa get her beauty rest. I got out of the shower and went downstairs to walk around. My contractions were still quite spaced apart, but again, when they happened, they were certainly getting my attention. Peggy sat on the living room sofa and I walked around the kitchen island, taking big, wide steps and swaying my hips. Eventually my feet were hurting from standing in the shower and the numerous kitchen island laps. I told Peggy and Mary, "I don't know what I should do- keep moving to get these contractions going, or go lay down and rest." Mary started laughing and said, "I know what you would tell a patient." "Yeah? What's that," I asked? "Keep moving," she said! "Nah...I think I would say 'listen to your body.'" With that, I decided to go upstairs to rest. Laying down wasn't an option, so I sat on the birth ball and leaned over on pillows on the bed, as Mary rubbed my back. Glen laid a couple feet away on his side of the bed still sleeping. Eventually I became less aware of his obnoxious snoring and began to float in and out of sleep as Mary caressed my back. There was no sense of time for how long I stayed that way, but 30 minutes would be my guess. My contractions did indeed pick up, now feeling as if they were 2 minutes apart. The next memory I have is the shower being turned on for me and me now on my hands and knees, beside my bed. Mary walks in and asks loudly, "Are you having ANOTHER contraction?!" I think to myself, "ARE YOU REALLY ASKING THIS?! A little bit of observation goes a long way." I kept the thought to myself and kept my mouth shut. I got up and got back in the shower. At some point, Melissa woke up on her own and joined us.

I would intermittently try to sit on the toilet. That wasn't comfortable. I would stand for a contraction. That wasn't comfortable. I would sit back down, stand back up, sit back down. I would literally go up and down throughout my contraction, and this repetitive motion was a coping mechanism in itself.

I look at Mary and ask her, "Will you say some bible verses?" She says the first one that comes to mind:

"Fear not, for I am with you."

I nod. That's a good one.

Mary goes and gets her phone and searches for more applicable bible verses, as she seems to be stumped. She comes back reading them. I look at Melissa and matter-of-factly say, "Tell Mary her bible versus aren't very good."

We laugh at it now but at the time I was dead serious. Her bible versus weren't good enough.

Transition at its finest.

I get in the tub. My contractions were now 2 minutes apart and strong, transition contractions. It was quiet- myself included. Shortly thereafter I was getting the urge to push and began bearing down, silently, at the peak of each contraction. I never announced it to the room and I remember thinking to myself, "I wonder if they can tell that I'm pushing?" At this point the pain was intense and there were three things that made it better: silence, swaying my head, and having Glen close. I ask him if he would get in the tub with me. I needed the comfort of having him there, beside me. It is amazing how you can be in such intense pain that you are incapable of verbalizing, but yet your mind is still sharply aware and processing. I remember assessing, thinking of how I was so quiet and also thinking to myself how I was certain everyone in the room thought I looked like a crazy person, with my head swaying back and forth and my eyes rolling in the back of my head. I remember thinking, "If I had the energy to laugh, I would laugh at myself."
I would continue pushing for nearly 40 minutes, and at some point in the midst of that I had the realization that what I was doing was not working. Callen felt bigger than Adria and I felt like I was trying to push a 10 lb. brick out of my rear that was not budging, despite my best efforts. The midwife in me told me that I needed to change positions, get out of the tub, and go sit on the toilet. Oh, but everyone hates the toilet. The mom in me adamantly said hell no, that is going to hurt more. And so, true to the ways of being human, I stayed where I was. Eventually, probably 5 minutes before birth, I had a come-to-Jesus moment where I thought to myself, "Enough of this. You have got to just push and push HARD, as hard as you can, and get this baby OUT." I started pushing like I had never before in my life done, with any of my other babies, and for the first time in my labor, became vocal. For the first time ever, I felt the "ring of fire"- the burning sensation of my perineum stretching as the baby's head was crowning.

I roar and keep pushing, as hard as I can. I picture what usually happens with a multip, pushing this hard- the baby usually flies out. WHY IS THIS KID NOT FLYING OUT?!

"Top of the ears...keep going..." someone says.

"RAWWWRRR!!!!!!" Pushing as hard as I can...

"To his nose now..."

"Is his chin out," I ask?

"Keep going, give another push." It's Glen that says this.

I am pushing so hard...

Callen's head comes out. I have relief knowing that I'm almost done. Glen sees that Callen doesn't restitute and tells me to push to get the rest of him delivered. I give one last, long push and Callen is born into his Dad's hands. Peggy says, "Reach down and get your baby" and I reach down and lift Callen out of the water, onto me. It's 5:19am on September 30th, 2014.

I thank and praise The Lord, "Thank you Lord, thank you Lord, thank you Lord..." this is all I'm verbalizing, but in my heart and mind I know what I am saying...Thank you for giving me the capability, thank you for giving me the strength, and thank you for blessing me with this life.

It feels good to be done and to have my baby in my arms.

I get out of the tub, walk to my bed, and get tucked in with our new baby. The newborn exam is done with all of us watching, and Callen Grey weighs in at 9 lbs. 8 oz.

At 2 hours postpartum, Glen gets called in for another mom who would have her baby shortly thereafter, and Peggy stays for another hour, leaving Melissa, and Callen & I tucked in bed. Nicole, our nanny, arrives as Peggy is leaving, and I nap all morning off and on, with the big kids playing happily and excitedly downstairs.

Glen arrives home, happy to be back home with his wife, kids, and new son, and basking in how wonderful it feels to have also helped another family welcome their own son on the same day.

Friday, September 5, 2014

I often speak of the importance of a strong and trusting patient-provider relationship- what it entails, what it means, and why it is absolutely necessary. Specifically, I often speak of how it's even more so pertinent to our Out-Of-Hospital birth patients.

Out-Of-Hospital birth is an entirely different beast than hospital birth. For the patient, the family, and the providers alike. There are no epidurals, no pain medications- not even the comfort of having it as an easily accessible, immediate option. To do Out-Of-Hospital birth means to have a strong desire and a determined commitment- again, not just for the woman and her family, but her care providers as well. And trust...trust is the cornerstone. To have trust in each other is to know that everything is out on the table- concerns, fears, desires, expectations- and that we can mutually work together through it and for it. Trust is when the shit hits the fan and you think you may very well be dying because you are in the thick of it, but we look at you with guidance and reassurance and well, you ARE reassured that yes, it's ok, and yes, you CAN do this.

This morning was a perfect example of trust and commitment and how the patient-provider relationship carries that.

I helped support a family in welcoming their 3rd baby; not only their first Out-Of-Hospital birth, but their first unmedicated birth. I didn't see them at all throughout their pregnancy and therefore didn't (and don't) really know them in the way that I know my own patients. But what made them special is that they have been long-time patients of Glen's.

I remember first meeting Randi- at a childbirth class I taught at the office. Afterward we stood and chatted briefly. She hadn't previously considered a birth center birth, but after learning of her options and wanting the same doctor- her doctor- she changed her plans for birth. She looked at me and said, very matter-of-factly, "We've had two babies with Dr. Elrod. I'm not having a baby without him. If I need to have a birth center birth to guarantee that he'll be there, then I'm having my baby here. I'll go wherever he is."

I remember going home and being amazed, repeating those words to Glen. Yes, a relationship and trust are very strong things.

Just like any woman experiencing natural childbirth- there were a few- but brief- intense moments. It may have been her 3rd baby, but Randi had never felt THIS before. In the small birth room, in the corner tub, surrounded by the decor I myself love and deliberately selected, with her husband by the side of the tub, and Glen and myself kneeling in front, with the urge to push and not knowing what to do she exclaimed, "Dr. Elrod, please help me!"

The room was dimly lit by the sconces that light up on each side of the bed. The same sconces we have in our home. The wood headboard that was made locally. A room that not only has what is needed to practice evidence-based care and safely have a baby, but that also feels like the kind of environment that is conducive to a family actively working together and welcoming their new baby.

Glen looked at her and reassured her that her baby's head was right there. She pushed 3 times and the baby's head was out. She looked at me- directly and intentionally- and said entirely calm and collected, yet every bit as intense as the words she spoke,

And with that, one more push and she delivered her baby girl- into the water, into Glen's hands and then immediately up to her chest. Even though she was admittedly scared, she was strong, and SHE DID IT!

Riley Dawn was born today- an uncomplicated, unmedicated, beautiful waterbirth. Mom and baby are doing great, and Dr. Elrod is pretty proud too!

Monday, July 21, 2014

We
don’t usually update this blog with events of our life- specifically, our
personal life and daily adventures, but I thought it would be a nice change to
give such an update. Life has been busy, with a lot of excitement and good
around us!

The
weather in Alaska has been beautiful- mostly warm days and not too much rain.
With our long, sunny and mild days, it leaves the world buzzing. We have our
work days but still seem to have plenty of time to enjoy our “down time.”
Parades, festivals, markets, fishing, outside lunches at our local brewhouse,
and the various classes and meet-ups that we have at our office have left us
busy and enjoying our summer.

I’m
now 31 weeks pregnant and feeling excited about the upcoming addition to our
family. This baby boy has yet to get a name, but I’m sure that will come in
time. Afterall, I have yet to meet a person with no name. ;) We have been
blessed so far to have had a healthy and uneventful pregnancy and have enjoyed
having a midwife for our prenatal care, including the home visits that she does
for us. It’s been amazing for us to see how much Adria (our 2 year old) has
really seemed to understand. She certainly seems to understand that a baby is growing
inside of me and that we will soon have a baby join us, to feed and to care
for. Though it’s been awhile since she herself nursed, she seems to be familiar
with the idea that mom will be breastfeeding the new baby, as shown by her
demonstrations. Perhaps it’s a testament to her exposure of pregnant and
nursing women that she sees in the office.

As
for birth, we are looking forward to another homebirth, in the company of our
midwife, Peggy, the bigger kids (minus Candice who will still be finishing up the
Fall semester), and our two other support people- my cousin Melissa, and our
friend Mary. I can’t honestly say that I look forward to the challenge that
labor brings (yes, even if it is my 4th time around, it’s still the
biggest challenge!), but I do take comfort in knowing that I’ll be surrounded
by these very special people.

Last
week we celebrated a milestone for our practice- the beginning of offering
medical spa services. Glen has wanted to venture into medical esthetics for
some time now, but with being a solo practitioner for so long and focusing on
building the practice, there was little extra time to focus on anything else.
Now, with various changes in our practice and in life in general, now was the
time. It has been such an interesting and fun time to develop this aspect of
the practice, and one I’m happy to see become a reality- for Glen as well as
for the women who will utilize it. You can check out akbloomspa.com to see the listing of services.

When
this practice was a fledging practice and when we first began planning the
building we are now in, we envisioned that it would be a mecca for women- a
place for health and wellness, encompassing preventative care, treatment,
education, beauty, and other complimentary services. We still have so much that
we envision, but to think that much of what was only a vision 3 years ago is
now a reality, is a beautiful thing.

June 2012- the view from our property, which had yet to be cleared.

July 2013

The
open house for Bloom, the Medical Spa at Integrated Women’s Wellness, was a
huge success. HUGE. So many women from our community came out to enjoy a night
out and learn about the services that the medical spa is offering. Even though
technically us and our staff were working, we all truly had fun. We dressed up,
ate, drank, got to show off our Integrated Women’s Wellness home, and talk
about esthetics. In just two short hours, we booked about $10,000 in services.
Amazing to me, because in the back of my mind I always wondered how successful
a medical spa would be in Alaska. Afterall, we are not in San Diego or Los
Angeles! It’s a bit of a different climate...literally and figuratively. At the
end of the day, however, Californian or Alaskan, women are women, and to feel
good on the inside as well as the out seems to be universal. While to be
financially successful is of desire and benefit to us, at the end of the day,
the most satisfaction comes from offering a service that will make a difference
in the lives of women…and to be the best at doing so. ;) This concept is a cornerstone
of Integrated Women’s Wellness.

So,
what’s next? We will continue to build up the esthetic aspect of the practice,
continue to add various classes to our class offerings, countdown the days
until we meet our new baby, prepare for our upcoming birth center inspection,
host a Betula Baby table at the Alaska State Fair, and bid farewell to Dr.
Wayman as she relocates back home, at the end of next month. In September I’ll
celebrate my two year anniversary of being a licensed midwife. I have several
repeat clients right now, and to have the experience of being a woman’s midwife
throughout more than one pregnancy is truly special.

There
is plenty to come- both personally and professionally- and we are excited about
it all!

Friday, June 27, 2014

While cloth diapering seems to be growing more and more in popularity, it seems there are no shortage of people who are still scratching their heads and mind.blown. when they find out that we cloth diaper. [Insert the Whats?! and the Whys? And the 'That is disgusting!'] I mean really, why WOULD any sane parent want to subject themselves to not only more contact with pee and poop, but also...more work? Well, read on.

We haven't always cloth diapered. In fact, prior to my last baby (Adria, now 2 1/2) when I envisioned cloth diapers, I seriously envisioned a prefold with metal safety pins, all held in to place by good ol' rubber pants. And, I'm not even sure I've ever seen a pair of real-life rubber pants, but that's what I had in my mind. Leave It To Beaver days.

Little did I know that these aren't the days of my momma's cloth diaper. Things have changed. Cloth diapers are not only not scary...they are wonderful. And cute. And addictive.

One day, in the earlier part of my pregnancy with Adria while I was meandering through a baby fair, I came upon the display of a diaper service business. The lady was nice and the information was profound. I took the information and then I went home and researched it. I knew soon thereafter that we were going to be cloth diapering. My husband- the doctor and also a man of convenience- surprisingly didn't bat an eye...once it was explained to him that he would not have to wash them.

THE BENEFITS OF CLOTH DIAPERING

- Avoidance of the chemicals that are found in most disposable diapers...Bleach, chlorine, 'superabsorbent' gel, dyes, and fragrance.

- Environmentally friendly:Cloth dipes are much less of a strain on Mother Earth than disposable dipes. If you do a bit of research, you'll find the more than 200,000 trees each year are lost due to the manufacturing of disposable diapers for babies (in the U.S. alone!). In addition, it takes 3.4 billion gallons of fuel oil every year to make diapers. It's estimated that disposable diapers require 20 times more raw materials, two times more water and three times more energy to make than cloth diapers. Pure cotton, bamboo, or hemp are much friendlier for Earth Momma!

Also, cloth diapers equate to reduced waste in our landfills. It's thought that disposable diapers take hundreds of years to decompose in our landfills (though we don't know how long, exactly). Think of all of the diapers your little one goes through each day...now each week...each month...and each year. Yep, that's a lot of diapers. Cloth stays out of the landfills!

- Less diaper rash.Why? Refer back to the first benefit discussed. Yep...no artifical chemicals and dyes means nothing to irritate baby. Also, because cloth diapers have none of those 'superabsorbent' gel beads or lining to soak up urine for hours, it does require more frequent changing. This is a good thing, I swear! This also attributes to less incidence of diaper rash.

- Fashion.
If you haven't already checked out some styles and prints of cloth diapers, do it. But prepared to become obsessed. There are many different styles, colors, sizes, and prints. At my shop, Betula Baby (who I run alongside the Tidy Tush, a local diaper service), we keep it simple and carry Thirties, Rumparooz, and Alva.

LET'S TALK MONEY

Being the owner of a baby boutique, I of course love to help out moms and dads support their cloth diaper addiction. But even with all the fun and funky prints and accessories taken into consideration, cloth diapering can equate to SAVING money! I did a quick online store price eval and found that it's pretty average for mid-range diapers in a value pack to be about .25 cents each. If you cloth diaper and choose to wash your own, the yearly cost of diapering can be significantly less than those disposables. If you're like me and choose to use a a diaper service, it still ends up being slightly cheaper (though, depending on where you live and the price of your service, it could end up being about the same or slightly more. BUT- refer back to the aforementioned benefits of cloth diapering. My vote is- it's still worth it.)

Our local diaper service is Tidy Tush and the yearly fee is $900. For $900 you get all the pre-folds that you need, tote bags for pick up and drop off, and the luxury of getting your diapers freshly and beautifully laundered and delivered right back to your door. And, if you're blessed like me, your very own lovely Tidy Tush diaper lady is also included and at your disposal for all of your diapering and baby questions. ;-)

THE HOW TO'S (Let's not make mountains out of molehills...it's pretty uncomplicated. Really.)

Remove diaper from baby.
Put the diaper in the diaper pail or wet bag. Yes. Nastiness and all. (No worries, you have a get out of jail free card until about 6 months or whenever you begin solids. Then the turds come.)
Put pre-fold diaper insert into diaper cover. Snap (or velco) shut.
Put dirties out on porch on diaper day.

Ok...there's my regimen. That was easy!

But what if you choose to wash them yourself? Then continue on.

4. Throw diapers (and wet bag, if you use one) into wash. Wash twice on Heavy Duty (some choose to use a bit of bleach, some don't and just use a basic detergent), and if all is well and no ammonia smell is present (then that calls for a simple vinegar soak, if so), then put through another cycle, but with no detergent or bleach. This is the in-depth rinse cycle, getting the diapers agitated, spinning, and rinsing in just plain water. Repeat again.

5. Dry. (Some hang dry, our 'diaper lady' puts them in the dryer.)

And lastly...

ISN'T IT COMPLICATED TO CLOTH DIAPER?
(Yeah...no. If we can do it, so can you!)

There are many options when it comes to brands and types of cloth diapers, but we keep it simple and use two things: A waterproof cover (Thirsties, Rumparooz) and a cotton pre-fold. Put the pre-fold inside the liner and wa-la! You've done it.

Why do I personally prefer covers and prefolds? Well, because it's less bulk for the wet bag and less wash (even if I don't technically wash them myself, I still care.). Unless the baby has pooped or seriously messed up the cover, it is easily wipeable and then made new by a fresh pre-fold.

So...for all the moms and dads who are shocked or fascinated or even curious about cloth diapering, now you know. We aren't the most 'crunchy granola', we don't exactly have oodles of spare time on our hands (if you know us, this statement is funny...), and we don't particularly like extra poop exposure or extra work...but, WE LOVE CLOTH DIAPERING, for oh so many reasons!

Friday, March 21, 2014

The night before last we worked a night shift at St. Therese. Glen and I were accompanied by Keri, the doula from Connecticut who we have been blessed to meet and share this trip with, and our translator Shelly.

When the sun sets over St. Therese, the vibe noticeably changes. The unrelenting heat that beats upon the dirt and the concrete, and the thick, heavy stench of dehydrated urine, feces, amniotic fluid, blood, and unbathed, moist bodies give way to the night sky. The scorching sun departs, and the Haitian sky welcomes the moon, which brings a yet still warm night, but one that gives the comfort of an intermittent cool breeze.

The hustle and bustle slowly dissipate as the hours draw by, consistent with the slow but steady drop in temperature. We can feel the difference in the air even in just a couple degrees, and for that, we are thankful. The patients who are here to stay retreat to their beds for not only the comfort of a soft place to lay and potential sleep, but for the protection that the mosquito net brings. Each ward closes its doors, guests and family retreat for the night, and the metal gate to the hospital is shut to the outside world. The moans, yells, and shouts to Jesus of the day no longer occur, but are now replaced with cries that are coming from the new Haitian lives residing in the postpartum unit- the babies that were born today and yesterday.

What I notice for the first time in this sanctuary lull, is the sweet aroma that fills the air. Gone is the invasion of bodily fluids, but now the air is filled with the presence of sweet flowers. It is Heaven on earth. I take deep breaths of the fresh air and I speak to Glen of how beautiful it smells. I wonder why we have never noticed it? Funny how when darkness falls, when your world and heart are quiet, you become more aware of what surrounds you. Beauty is in the little things, yet so often we fail to see them through the busy or the bad of everything else that is occurring. But it's still there.

Earlier today, at about 1pm, a woman in labor walked into the maternity unit. I took one look at her and said to my translator, "That is a big belly for a Haitian belly! She has to have twins." I would bask in my observation skills, as minutes later we would find that she was indeed carrying twins. And term twins at that. Glen did an ultrasound and confirmed that Baby A was vertex and Baby B was breech. She would be 5cm then, and when we returned for the night shift, she had not yet delivered. At about midnight, I asked if I could check her and found that she was 8cm, Baby A was nearly +3 station, and a tight bulging bag right inside her introitus. I said to Glen and the Haitian midwife in charge that it was bound to burst any minute and I felt it would be better to rupture it in a controlled fashion, allowing it to leak. I felt the baby would come right away. Seeing as this was twins, Glen was hesitant to do that, and the Haitian midwife said absolutely not, for fear of a cord prolapse. In my mind this was silly at this point, as the baby's head was filling the vagina. I nodded and said ok. I do not deliver twins, as they are outside of the scope of my care. I was not the primary provider, so it was not up to me anyhow. Just my 2 cents. I then told Glen and the midwife to prepare for delivery, as once that bag broke, we would be having babies. While Glen made sure Pitocin was drawn up, clean instruments were out, and the PPV mask was out, I geared up in delivery garb, to help wherever needed. I stood there, feeling how I imagine new Haitian babies must feel- hot in the stagnant heat, yet swaddled in layers of non-breathable clothing. Within minutes a pop and explosion, a powerful burst of amniotic fluid ruptured 3 feet across the room, followed immediately by Baby A's head. I was the only one gowned and gloved. I stepped over and immediately caught Baby A. Glen garbed up in the protective gown and gloves and stepped in for Baby B, as we knew this baby was frank breech. Just a few minutes later, this second baby made her way into the world, rump first, to join her sister. Mom would go on to have a postpartum hemorrhage, which would be controlled with Pitocin and Cytotec. She, and her two new girls, would do just fine.

After mom was stable and moved to the postpartum unit, Glen and I would go to lay down to get some rest. Two hours later, we would hear commotion outside in the corridor. Glen said to me, "We better go out there. I think I heard someone say something about a mom pushing in the car." I grabbed my supplies and ran out to the exterior of the building, Keri and Shelly already two beats ahead of me.

What I see is gut wrenching. There are men lifting a woman from the van, trying to get her into a wheelchair. She is contorting, bucking, violently thrashing, in the black abyss of seizure after seizure. I throw gloves on as I yell over the commotion, "Is she pushing? Did she deliver?!" Shelly says to me that she has already delivered. I yell, "Where is the baby? Is the baby alive?!" I have no idea if she is 24 weeks or 40. IS THE BABY ALIVE?!" I must yell it three more times, as no one hears me, there is such commotion and attention on the violently seizing mom. Finally Shelly says, "Yes, the baby is alive." She is so calm, almost too calm. She talks and moves in slow motion, and I know that this is because her eyes and ears are acclimated to scenes such as this. Shelly points to a man, still in the van, and I see he has a bundle of miscellaneous cloth in his arms- shirts, scarves, I am sure anything they could find to keep the baby warm. I step to the open door of the van- as mom continues to thrash like a wild animal that the men are trying to tame- and I see the blood. There is a sea of red blood on the floor of this van, spilling onto the dry dirt ground that I am standing on. I grab the cloth bundle and prepare in my mind for what I might see. I have no idea what the condition of this baby will be. I take the bundle and immediately something falls down out of the cloth- the placenta hits the filthy, bloody floor of the van, acting as an anchor in this Red Sea. I have no extra hands to pick it up, and I we are tethered to the van. Keri instinctually steps forward as if to grab it for me, but immediately halts, as if in line with the shout in my head that has exclaimed, NO! She realizes, as I realize, that she has no gloves on and is not protected from whatever lies within that blood. She sees a clean, dry towel sitting on the seat, and uses that to pick up the placenta. Together, stride for stride, we walk as quickly as we can back to the maternity unit. The baby is alive and breathing well, has good color, but feels as cool as I imagine a cadaver must feel.

We remove the baby from the sopping wet garments and clamp and cut the cord, detaching the placenta. I look to see what this baby is...she is a girl. It is the least of my concerns, but as I dress her in what I have brought in my backpack, I am sad that all I have are boy clothes. The scene is stark in my mind- a new Haitian baby, whose mother continues to seize in the background, is getting cared for and dressed for the first time by a disheveled, hot mess of an American who is dressing her in boy clothes.

Keri and I would take turns holding her up against ourselves, with an electric warming pad pressed up against her back. This is how we kept her warm, bringing her temperature up from the 95 degrees it was on arrival.

The following day, the mom would be stable, conscious, and alert. Keri and I would go visit with her and help to get her baby girl latched to the breast. The importance of breastfeeding...it can be the difference between life or death here. To see a woman who I thought may very well die just the night before, now alive and nursing her baby, this was amazing. Even in a room overflowing with sadness and terrible things, this was a beautiful, wonderful thing to see and to be a part of.

There is beauty everywhere. Even when we are in the midst of bad, even when we are too overwhelmed or busy to take notice.

Thursday, March 20, 2014

It started like any other morning in
Hiche; cereal, coffee, some quiet banter about what everyone was
going to do for the day. Tara and I were not supposed to be headed
to the hospital until the PM shift-2 to 8pm. We took our time in the
morning, getting some relaxation and ultimately looking for something
to do to pass the time.

We found out they needed cord ties made. Once 100 were
made, they would autoclave them to sterilize them. These cord ties
consisted of 3 pieces of string, each 7-8 inches long, rolled up into
a ball, then wrapped in paper. Tedious work, but it was keeping us
occupied for a few hours.

Suddenly, Nadene comes down with an
urgent phone call from Wendy. There was an ectopic on the unit and
she was headed to surgery soon and the Haitian OB wanted my help. I
took about 2 seconds for me to hop up, gather my gear for the day and
head out. My only mistake was forgetting to fill up my water bottle.
In this heat, that wasn't a good mistake to make.

The moto ride is usually a casual,
leisurely ride from the house. This ride was no different, although I
was imagining this mom having a ruptured ectopic and bleeding out as
I was taking a gentle stroll though town. I need to go faster!!!

I get to the unit and things seem
relatively calm. The OR is on hold because of a general surgery
case. I learn later that it is a radical mastectomy being done.
Recurrent breast cancer, apparently. I'm shocked to see such a
surgery done here. But, I digress. The mom with the ectopic is
stable, thankfully. She is obviously in pain, but vitals seem normal
and no immediate distress. And due to the delay, it's a good thing
she is stable.

I sit and wait for the OR to come get
this mom for surgery. I turn my head toward the door because there
seems to be some commotion. A mom was being helped in to L&D by
two men. She's in pain and sounds like she is in labor. She takes a
few steps and blood is pouring from her onto the floor. Flowing from
her, steadily running down her legs and onto the already filthy
floor...it is truly a horrifying sight to see. Regardless of the
cause, she most likely needs to be delivered quickly. First, I find
heart tones...baby was alive. Next, I use the crude ultrasound and
rule out a previa. I her IV fluids that she walked over with- two
IVs hanging- LR and magnesium. Her blood pressure was 170/120.
Imagine that...another preeclamptic. Another complication from
preeclampsia. There was no doubt she was abrupting and urgently
needed to be delivered. But...so did the ectopic. And there was
still that pesky mastectomy going on.

I looked at Wendy and said, “This
might be very bad. With the delay, we could easily lose all three
(meaning the ectopic mom, the pregnant mom and the baby.)” And it
could be quickly.

I thought of this were my decision to
make, who would be the first priority? The ectopic could go bad
quickly, but it also would be a relatively quick surgery. The
abruption, though stable at the current moment, had both the lives of
mother and baby at stake. There is a prioritization of life being contemplated...and the Haitian OB makes the call that the
ectopic gets to go first.

A bubbly, Hispanic guy named 'Romero'
came bounding into L&D and introduced himself. It turns our
Romero is our anesthesiologist. He has come to see the ectopic. I
assumed at this point that the general surgery case is done. I was
wrong! Romero left the OR, came to see the ectopic, got her back to
the OR and placed her spinal, all while the mastectomy was taking
place. As crazy as it sounds, that is exactly what needed to happen
here. Time was ticking and there was none to be spared if a life was
not to be lost.

I am doing the ectopic with Jean
Baptiste, the only other Haitian OB that I had not yet met. He is a
very nice man. You can tell he cares about his work and his
patients. As we prepare to begin the case, he reaches over and
firmly grabs my hands...holding hands with a man I have just met and
whom I do not understand his language, he says a prayer in Creole.
This work and situations such as these, transcend the expertise and
skill of any surgeon. We need all the help we can get.

We start and as soon as we open her
belly we know that it is a ruptured ectopic, blood fills her belly.
The right tube was distended and ruptured. We take it out. The left
tube was severely damaged and we both agree she may never have kids.
My guess is that she had an STD at some point that has ruined her
tubes. Sad, but it is the reality.

Ruptured right fallopian tube.

Headed back to L&D I'm hopeful that
the abruption mom is still stable. She is, only now we still wait
for her turn. This time we do wait for the mastectomy to finish,
probably another hour at this point. All together it was nearly 4
hours between when she came in with an 'emergent' reason for delivery
and when she actually delivered. Lucky for her, she maintained
stabilty for the duration.

Surgery was uneventful. Dr. Celestin
let me do the case and it was like any other c-section. Baby did
great and mom did great. Her placenta didn't exactly look like an
abruption, but her uterus had ecchymosis (bruising) that appeared to
be a classic Couvelaire uterus with bleeding into the uterus. A good
call to deliver by section. And a tubal after this her 10th
baby was also done.

By this time, Tara and Kerri (a doula
from Connecticut) had arrived to work the PM shift. Things were
oddly quiet for a while. As it usually happens, more commotion.
This time it is several men and one tiny woman carrying in a mom on a
stretcher. It was her first baby. She was 30 weeks by their
discussion, but looked more close to term. She had been in labor and
had been under the care of a Matron (a local, traditional birth
attendant) and she had apparently seized several times prior to
being brought to the hospital.

Matrons are traditional birth
attendants. These are both men and women that have grown up watching
others in their village attend births. They have learned their
skills by observation, being taught be matrons before them, folk
lore, and probably a bit of voo doo thrown in for good measure.
Matrons often have had no formal training in birth at all. Yet,
because of the long history of using matrons, these women are very
much a trusted part of the community. (Midwives for Haiti has begun
a series of classes to teach the basic medical skills needed to
provide safer care to the women in these remote village without
access to midwives.)

On first evaluation, her blood pressure
was 140/120, baby's heart beat was 120 and she was complete and plus
2. All in all, she was pretty stable. She continues to labor as the
midwives work to start her IV, hang magnesium, and wait for her to
deliver. Over the next hour or so, it becomes clear that her
seizures have left her exhausted and her pushing efforts are
non-existent. Tara wonders and questions o the Haitian midwife
whether a section would be in order at this point. She unobtrusively
asks how long they will wait before making that decision. In her
mind, I can see the reasoning. A first time mom who has knowingly
seized several times and while now arguably relatively stable, she is
not coherent and hardly conscious. I can tell she feels this should
be happening. One of the Haitian OB doctors checks the patient and
says that he will give her a bit more time before ordering pitocin.

I can't say that listening to heart
tones is a regular thing here. There doesn't seem to be a protocol.
We tried as best as possible to listen consistently every 20-30
minutes, but in an environment of chaos and a lack of staff, it is
difficult. In this case, we listen and find the heart rate in the
70s! It stays in the 70s. We set in motion the means to get a
section done. I notify the anesthesiologist, the midwives call the
Haitian OB. The heart tones have come up a bit to the 100s, but are
still low. I was very surprised, pleasantly surprised, that things
went very quickly towards section. Within minutes of my notification
the OR was in the room to get her. Within a few more minutes she was
off to the OR. In the OR, she had a spinal placed mostly on her
side, but I'm fairly certain that he nearly put it in with her on her
belly. For those that know OB anesthesia, you'll know this is no
easy task when they can't sit straight up or lie still on their side.

The only thing missing was the Haitian
OB. Once her spinal was in, the anesthesiologist and scrub tech yell
at me and motion for me to just start. “You...go!!!' Hesitantly,
not wanting to break any rules we agreed on at the beginning of the
week, I decide to scrub. It is either that, or we might lose this
baby. Just as I'm prepping the belly, the Haitian OB walks in and
motions for me to continue. It looks like I'm on my own. He doesn't
scrub.

I quickly get to the uterus and open
it. Mec...lots and lots of thick meconium. Not terribly unexpected,
but also not a great indicator of what I'll find. The baby was limp
and apparently lifeless. I knew, however, that there was a set up
for resucitation handy, just in another room. I quickly hand the
baby off and finish the section. All is well with the mom. I find
out that the baby has actually done well. Initial heart rate was 130
and only needed bag mask to get started.

All in all, a busy day. I have found
that the willingness to call for a pediatric nurse and have them
called for every birth has truly been a life saver. There is no
doubt in my mind that without a skilled pediatric nurse for this last
baby, that she would have died. For that one change since we were
here last, I am grateful, as well as proud of this program. There is
change being made.

Tuesday, March 18, 2014

The room Glen and are staying in while here with Midwives for Haiti is a small room that, on our arrival, had a twin bed and a single mosquito net canopy above it. Acknowledging that Glen and I are two people- husband and wife, it was offered that another twin size bed be carried into the room and placed beside the existing twin bed. The first night we arrived, this is what was done. Glen and Steve moved an entire bed from one room to the other, all so that we would have a comfortable place to sleep, together. I joked to Glen that having a bed big enough to share was the least of my concerns. I came to Haiti to work, not to make love or to cuddle. And besides, the idea of being pressed up against a hot, sticky body was not appealing to me.

I thought about this as we drove through the streets of Hinche. Riding on a moto or in the back of a jeep through the unforgiving, unpaved dirt roads, you see the rickety, tattered shacks that are the homes to the people in this town. I found myself wondering about the lives of the men and women and families that live there. I thought of my own relationship and life with my husband and wondered if those personal, intimate moments in life could possibly be the same here? Does the woman and her husband lay in bed and discuss their life? Do they hope and dream and plan for the future? Do they make love to purposely make a baby? Or is the prospect of adding another baby scary? Is it a burden...is it another mouth to feed? What does that life look like from within those dilapidated walls? A home that is not even a glorified shack. A home made of wood scraps, branches, dirt, metal, or if you have more than most, cement. Do they lay beside each other in the hot darkness...cloaked in sweat, dirt, and love? Does he whisper to her that she is the most beautiful thing in the world and that he loves her? Do they lay against each other and make love in their one-room windowless hut as their other kids or family members sleep just feet away? Do they have any idea how different life is for so many people...

It is simple to look at Haiti this way, to compare it to what we have back home, and inaccurately conclude that families must feel this way. But the reality is, we are all the same in basic ways, are we not? We put stake in the future by way of hope, we work hard to survive but also to improve and rise above from where we are, and we all make plans for the future. Why would Haitians be any different? Our life's treasures are not what we own, nor what we hold of monetary value and possession, but the family we create, the relationships we form, and the lessons we pass on to these people and in turn, the world. I suppose even in a country as Haiti, where access to the seemingly simple, basic necessities of life are not guaranteed, where pregnancy and birth carry the very real potential of death, the magnificent reprieve is that of Life and Love.

Today was our first day of work. Glen went to the hospital to help the Haitian OBs and midwives wherever needed, and I went on a mobile clinic to a town about an hour outside of Hinche. The mobile clinic goes to this particular location once a month. This enables the women and babies in this particular area to have access to quality care once a month, when before Midwives For Haiti came here, most went without. Without transportation and expendable money to be used on a 'tap-tap,' women simply could not reach a doctor or midwife.

The new Midwives for Haiti Landcruiser, which we donated toward.

We arrived to find that the house and church which was to be used as the mobile clinic site was locked up, with no way to access it. Women and babies had already lined up, waiting on our arrival and anticipating to be seen. Something so trivial as having no access to the building was not going to make us skip a beat. These women and babies needed to be seen. A couple midwives walked around the property and found a wooden picnic bench. This would be where the women would sit and wait for their turn to be seen. There was a permanent, cement table placed in the center of the shaded veranda, where the midwives would then make a makeshift pharmacy and urine dipping station. Meanwhile, someone set up the portable exam table that we had brought along with us. A backpack strapped to my back, a doppler on my waistband, stethoscope around my neck, I placed my measuring tape, doppler gel, and blood pressure cuff on the exam table to make my "exam room." A basic set up with minimal supplies, out in the middle of nowhere Haiti, and we were equipped to save a life by way of preventative care, education, and screening.

Keri and I. She's an American doula.

This is where we hosted our clinic.

My 'exam room.'

The morning proved to be uneventful. I went from woman to woman sitting on the wooden bench and took each woman's blood pressure. I was honestly astounded by the beauty of each reading...105/60, 110/60...I'm not sure I had seen such great (normal!) blood pressures during our last trip. I made it a point to tell each of these women how great their blood pressure was, how their baby palpated head down, how wonderfully and completely normal they were measuring. Throughout the late morning patients, a young boy would come up to me, eagerly searching for conversation in his broken English. "Allo, what is your name," he asked me? "My name is Tara," I told him.
"How old are you?" He answered that he was 15. "How old are YOU," he asked me? I smiled at that. "I'm 30." I thought about it more and laughed. "Ha! I'm twice your age...15x2!" He laughed with me at that. I was puzzled at his presence. "Why are you here? Obviously you are not pregnant." (He laughed at this.) He responded saying, "I am here to be a guest!" Okaaaay. I wondered why in the world a 15 year old boy would come here to hang out...to watch pregnant women and busy midwives meander around in the hot sun, as if it were entertaining? Very puzzling to me, but I shrugged and went about my business, smiling at the oddity.

The mild morning warmth quickly stretched into the blazing afternoon, and the steady stream of patients became just a few remaining. One of the last remaining patients got up on the exam table.

"Bonjou! My name is Tara, I'm a midwife. As I began to talk, I instinctively put my hands on her belly feeling as I spoke. Her soft, stretched, gravid belly reminds me of a momma who has carried 10 babies within her throughout her life.

"What baby is this for you?"
"It is my 4th."
It creeps into my mind...she is expecting her 4th baby, just like me. We are two women, in the same phase of life. She is like me. I am like her. Yet so far...

"How are you feeling?"
"OK", she responds, after my translator has translated what I have said to her.
"When are you due," I ask?
"April," she says.
"Is your baby active?"
"Yes."
"Do you have any complaints...headaches?"
"Yes," she says, I have had a headache for 3 weeks."
Hmmm.
"Are you having any visual disturbances?"
"Yes, I have been seeing spots for 3 weeks," she tells me.
"What was her blood pressure," I ask Pleasure, my interpreter?

He rummages through the paperwork I've just been given by one of the midwives, who took her blood pressure a few moments ago, with an automatic cuff.
Pleasure points to a number, and even though I shouldn't be surprised, I am.

It says 210/110.

I quickly finish examining her...I note no edema, I measure her and she measures appropriately, I palpate and the baby is head down...and then I listen, hesitating in my mind because blood pressure like that makes me wonder if baby is even still alive. It is. I tell her that her blood pressure was very high and that I would like to take it again, myself, and manually this time. She sits up and I put the cuff on. When I hear the first beat and when I hear the last, I am yet again surprised. There is NO WAY her blood pressure is what I think it is. I have to take it again.

I take it again and get the same reading. I have never in my life, even in Haiti, seen a blood pressure this high. I switch arms and I repeat it yet again. It is indeed the same.

240/140. I type those numbers and I honestly cannot wrap my mind around it. If someone would have told me that there was a person with a blood pressure this high, I likely would not believe it. I looked her in the eye and I said to her, "You must go to the hospital." She stared back at me, expression unchanged. I knew she did not understand the severity of the situation. I am sure that is the venom of hypertension...it is silent. It does not hurt. It creeps up and up and up, unbeknownst to the invader, silently destructing and wearing down the body from the inside.

I sat down beside her and my translator translated quickly as I went. I looked her in the eyes, just inches from her face, and this time, I recognize those sweet eyes. They belong to that boy. The 15 year old who wants to be a doctor, who was half my age, who was talkative and silly. He belongs to her. She is his mother.

"You MUST go to the hospital, right away. Blood pressure this high can cause you to have a stroke, can cause you to lose the baby, and can kill you. I know it is far, I know nobody wants to go to the hospital...but it is better than dying. Do you understand?"

She looked at me and nodded, and I felt she truly understood. I said to the Haitian midwives, "She needs blood pressure medication right away. Do we have anything?" One midwife brings over some pills, and before she gives them to the woman, she asks her if she has had anything to eat today. The woman says yes, that she had a cracker this morning. A cracker. Nothing more.

I remember the snacks in my bag and I tell her that I have some peanuts in my bag. Would she like some? She eagerly says yes, yes please. I give her the peanuts, brought from Alaska, gifted to me from my dear friend Mary. She sits there like a silent ticking time-bomb, quietly and happily popping honey roasted peanuts into her mouth, and I wonder to myself if she and her baby will make it.

The writing on the tag says, "I do not give lectures or charity. When I give- I give myself." Walt Whitman

I wanted her, so badly, to ride back with us. I wanted to see her arrive to the hospital safely. But, she insisted that she go home to tell her husband where she was going and to get the items she would need for delivery (a sheet, a towel, a bucket, baby clothes). I wondered what all this truly mattered, if it meant further putting her life at risk. What does a baby outfit and a diaper do for a dead baby? My heart sank as we loaded up. I walked over to her, one last time and spoke with her, "I want to see you and your baby healthy. Please do not delay in getting to the hospital. I will be looking for you." She smiled, and we said goodbye- all of us headed down the rugged dirt road, cloaked in sweat and dirt, yet filled with love for this work.

I don't know if she made it to the hospital. I don't know if she will be ok. I don't know if I will ever see her again. But I hope...